Gathering expert consensus to inform a proposed trial in chronic nonbacterial osteomyelitis (CNO).

Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disease that primarily affects children and adolescents. CNO is associated with pain, bone swelling, deformity, and fractures. Its pathophysiology is characterized by increased inflammasome assembly and imbalanced expression of cytokines. Treatment is currently based on personal experience, case series and resulting expert recommendations. Randomized controlled trials (RCTs) have not been initiated because of the rarity of CNO, expired patent protection of some medications, and the absence of agreed outcome measures. An international group of fourteen CNO experts and two patient/parent representatives was assembled to generate consensus to inform and conduct future RCTs. The exercise delivered consensus inclusion and exclusion criteria, patent protected (excludes TNF inhibitors) treatments of immediate interest (biological DMARDs targeting IL-1 and IL-17), primary (improvement of pain; physician global assessment) and secondary endpoints (improved MRI; improved PedCNO score which includes physician and patient global scores) for future RCTs in CNO.

TNF-inhibitors or bisphosphonates in chronic nonbacterial osteomyelitis? - Results of an international retrospective multicenter study.

Chronic nonbacterial osteomyelitis (CNO) can cause significant morbidity, including bone pain and damage. In the absence of clinical trials, treatments include non-steroidal anti-inflammatory drugs, corticosteroids, TNF-inhibitors (TNFi) and/or bisphosphonates. In a retrospective chart review in the United Kingdom and Germany, we investigated response to TNFi and/or pamidronate. Ninety-one patients were included, receiving pamidronate (n = 47), TNFi (n = 22) or both sequentially (n = 22). Patients with fatigue [p = 0.003] and/or arthritis [p = 0.002] were more frequently treated with TNFi than pamidronate. Both therapies were associated with clinical remission at 6 months, and reduction of bone lesions on MRI at 12 months. While not reaching statistical significance, pamidronate resulted in faster resolution of MRI lesions. Fewer flares were observed with TNFi. Failure to respond to pamidronate was associated with female sex [p = 0.027], more lesions on MRI [p = 0.01] and higher CRP levels [p = 0.03]. Randomized clinical trials are needed to confirm observations and generate evidence.

Transverse bunch-by-bunch feedback system for time-resolved experiments at PLS-II.

A description of the upgraded bunch-by-bunch feedback system for time-resolved experiments at Pohang Light Source II (PLS-II) is provided. The bunch-by-bunch feedback system has been upgraded to increase the single-bunch current in the hybrid fill pattern of the PLS-II facility. The project is part of the SPring-8 and PLS-II collaboration. The main features of the upgrade are to employ a single 500 MHz analog-to-digital converter (ADC) instead of the previous four 125 MHz interleaved ADCs for 500 MHz rate, to replace a single-loop two-dimensional feedback with two independent one-dimensional feedback loops, to implement the tune measurement function with a single bunch, and mainly to implement single-bunch and stretcher control. The realization of a 400 mA hybrid fill pattern including a 10 mA single bunch demonstrates the precision of the upgraded bunch-by-bunch feedback system.

[Tumors of the central nervous system in children and adolescents]. / Tumoren des Zentralnervensystems im Kindes- und Jugendalter.

CLINICAL/METHODOLOGICAL ISSUE: Brain tumors are the most common solid tumors in childhood and the most frequent cancer after leukemia. The incidence is continuously increasing. The WHO classification of brain tumors, valid since 2016, is now based on the combination of histological and molecular genetic diagnostics. STANDARD RADIOLOGICAL METHODS: Diagnostics are mainly performed with magnetic resonance imaging (MRI); only in emergencies with computed tomography (CT). METHODOLOGICAL INNOVATIONS: Diffusion and susceptibility weighted and dynamic contrast-enhanced imaging and spectroscopy are used. PERFORMANCE: Improved diagnosis regarding dignity, size determination, adjacency assessment, and morphological description of tumor composition. ACHIEVEMENTS: Modern MRI with functional techniques is now the gold standard for differential diagnosis and staging of central nervous system (CNS) tumors in pediatrics.

Forced locomotor activity improves walking ability of male turkeys and modifies carcass characteristics.

1. This trial investigated the effect of forced locomotor activity (training) on walking ability, leg posture, and growth performance, as well as carcass composition and meat quality in male fattening turkeys.2. A flock of 744 commercial turkeys was divided into three experimental groups, either without any training period (control), training from weeks 2 to 8 (short-term), or training from weeks 2 to 21 (long-term). All birds were slaughtered at an age of 21 weeks. To study the effect of short vs. long time lapse between shackling and stunning (suspension time), each training group was split into two halves that were hooked on the shackle for either 15 s or 3 min prior to stunning.3. Long-term physical training, compared to short-term or no training, resulted in better walking ability and in a lower percentage of leg malposition, as assessed at the end of fattening. No effect on final body weight was detected.4. In a subsample, the composition of 80 carcasses was determined by dissection. Long-term training favoured the percentage of the drumstick over that of the breast cut in comparison to the group without any training.5. Meat quality parameters were determined for breast muscle. The pH values 20 min post-mortem were reduced by long-term training, and the highest value was observed for a combination of no training with short suspension. After 24 h, pH values did not differ between experimental groups. The breast muscles were characterised as fast-glycolysing. Prolonged suspension time resulted in higher electrical conductivity after 24 h, and in higher a* values (redness).6. In conclusion, the study revealed that a long-term training period improved walking ability and leg posture of heavy male turkeys. Thus, training can contribute to the improvement of animal welfare in turkey husbandry. Meat quality variables of breast muscles were partially influenced by locomotor activity and suspension time.

Unexpectedly high incidences of chronic non-bacterial as compared to bacterial osteomyelitis in children.

Historically, osteomyelitis was considered an infectious disorder. More recently, inflammatory mechanisms were recognized causing a significant proportion of pediatric osteomyelitis. This study was to compare characteristics of children with chronic non-bacterial (CNO) and bacterial osteomyelitis (BOM). A chart review of osteomyelitis patients from the departments of pediatrics, pediatric surgery, orthopedic surgery, and oral and maxillofacial surgery was conducted in a tertiary referral center, covering the years 2004-2014. Institutional incidences of CNO (n = 49) and BOM (n = 56) were comparable. Differentiation between CNO and BOM based on clinical or laboratory findings was mostly impossible. However, children with BOM more frequently presented with local inflammatory signs (47 vs. 68 %, p = 0.040), fever (12 vs. 38 %, p = 0.003), and abscesses (0 vs. 39 %, p < 0.001). Peripheral arthritis (14 vs. 0 %, p < 0.001), inflammatory bowel disease (10 vs. 2 %, p = ns), and hyperostosis (29 vs. 4 %, p = 0.001) were more common in CNO. Whole-body MRI was performed in 76 % of CNO patients, unveiling multifocal lesions in 80 % (CRMO). Though considered a rare disorder, institutional incidences of CNO were comparable to BOM, and the discrimination between CNO and BOM solely based on clinical aspects was mostly impossible. This is of special interest, since a correct and timely diagnosis is of utmost importance for long-term outcomes in both disorders. Whole-body MRIs should be considered in chronic osteomyelitis to (1) detect clinically inapparent lesions in CNO and (2) indirectly exclude (usually unifocal) chronic bacterial infections. Prospective studies are warranted to establish evidence-based diagnostic and therapeutic approaches to CNO.

New recommendations on cerebral venous and dural sinus thrombosis from the German consensus-based (S2k) guideline.

Over the last years, new evidence has accumulated on multiple aspects of diagnosis and management of cerebral venous and dural sinus thrombosis (CVT) including identification of new risk factors, studies on interventional treatment as well as treatment with direct oral anticoagulants. Based on the GRADE questions of the European Stroke Organization guideline on this topic, the new German guideline on CVT is a consensus between expert representatives of Austria, Germany and Switzerland. New recommendations include:• CVT occurring in the first weeks after SARS-CoV-2 vaccination with vector vaccines may be associated with severe thrombocytopenia, indicating the presence of a prothrombotic immunogenic cause (Vaccine-induced immune thrombotic thrombocytopenia; VITT).• D-dimer testing to rule out CVT cannot be recommended and should therefore not be routinely performed.• Thrombophilia screening is not generally recommended in patients with CVT. It should be considered in young patients, in spontaneous CVT, in recurrent thrombosis and/or in case of a positive family history of venous thromboembolism, and if a change in therapy results from a positive finding.• Patients with CVT should preferably be treated with low molecular weight heparine (LMWH) instead of unfractionated heparine in the acute phase.• On an individual basis, endovascular recanalization in a neurointerventional center may be considered for patients who deteriorate under adequate anticoagulation.• Despite the overall low level of evidence, surgical decompression should be performed in patients with CVT, parenchymal lesions (congestive edema and/or hemorrhage) and impending incarceration to prevent death.• Following the acute phase, oral anticoagulation with direct oral anticoagulants instead of vitamin K antagonists should be given for 3 to 12 months to enhance recanalization and prevent recurrent CVT as well as extracerebral venous thrombosis.• Women with previous CVT in connection with the use of combined hormonal contraceptives or pregnancy shall refrain from continuing or restarting contraception with oestrogen-progestagen combinations due to an increased risk of recurrence if anticoagulation is no longer used.• Women with previous CVT and without contraindications should receive LMWH prophylaxis during pregnancy and for at least 6 weeks post partum.Although the level of evidence supporting these recommendations is mostly low, evidence from deep venous thrombosis as well as current clinical experience can justify the new recommendations.This article is an abridged translation of the German guideline, which is available online.

Macrocephaly, obesity, mental (intellectual) disability, and ocular abnormalities: alternative definition and further delineation of MOMO syndrome.

MOMO syndrome, previously defined as Macrosomia, Obesity, Macrocephaly, and Ocular abnormalities (OMIM 157980) is a rare intellectual disability syndrome of unknown cause. We describe two further patients with MOMO syndrome. Reported data of patients with MOMO syndrome and our own findings indicate that overgrowth does not appear to be a specific feature. We propose to form the acronym "MOMO" from Macrocephaly, Obesity, Mental (intellectual) disability, and Ocular abnormalities, excluding macrosomia from the syndrome name. The combination of obesity, macrocephaly, and colobomas is unique, therefore these features can be used as major diagnostic criteria of MOMO syndrome.

"Mutation negative" familial cold autoinflammatory syndrome (FCAS) in an 8-year-old boy: clinical course and functional studies.

Cryopyrinopathies are a subgroup of autoinflammatory syndromes. Most cases have mutations in the CIAS1/NLRL3 gene, encoding the cryopyrin/NLRP3 protein. Cryopyrin, together with other proteins, is involved in the assembly of the cryopyrin/NLRP3 inflammasome. Mutations in CIAS1/NLRP3 result in increased IL-1ß cleavage from biologically inactive pro-IL-1ß. This results in systemic inflammation and three associated disorders of different severity, forming a clinical continuum with overlapping features. The mildest from, familial cold autoinflammatory syndrome (FCAS), is characterized by remitting fevers, urticaria-like rash, polyarthralgia/arthritis, and usually caused by cold exposure. More severe forms are Muckle-Wells syndrome (MWS) and CINCA/NOMID. We report an 8-year-old boy with FCAS, who presented with overlapping features with MWS. He showed good response to seasonal anakinra treatment. Mutation analysis in CIAS1/NLRP3, PYCARD, and CASP1 was performed. Serum cytokine profiles, and cytokine expression from resting monocytes, and in response to mild hypothermia, and LPS stimulation were determined. Mutations in CIAS1/NLRP3, PYCARD, and CASP1 were not found. In response to mild hypothermia, an enhanced IL-1ß expression by patient monocytes resulted in increased IL-6 and TNF-α secretion, as compared to control cells. The addition of the IL-1ß receptor antagonist (anakinra) reversed these effects. In response to LPS stimulation, patient monocytes produced high level of IL-1ß, IL-6 and TNF-α. This was markedly less pronounced in control monocytes. FCAS results in cold-induced cytokine dysregulation and systemic inflammation. Symptoms can be treated, using IL-1ß antagonists. Further research is warranted, particularly in order to investigate pathophysiological mechanisms in "mutation negative" individuals.

Stabilisation of cardiopulmonary function in newborns with congenital diaphragmatic hernia using lung function parameters and hemodynamic management.

OBJECTIVE: Evaluation of lung function parameters and additional use of prostaglandin E1 (PGE1) for the stabilisation of cardiopulmonary function in patients with congenital diaphragmatic hernia (CDH) and pulmonary hypertension (PHT). DESIGN: Observational study. PATIENTS: Between 2007 and 2009 8 patients with CDH have been treated in our pediatric intensive care unit (gestational age 34 + 0 - 40 + 4 weeks, birth weight 2 160-3 840 g). All patients required respiratory support. Gentle mechanical ventilation adapted to the degree of pulmonary hypoplasia based on serially measurements of lung function parameters to find appropriate ventilator settings has been performed. MAIN RESULTS: Functional residual capacity (FRC) and compliance of the respiratory system in all patients were markedly reduced. A FRC between 9.3-10.6 ml/kg and compliance between 1.1-1.8 ml/kPa/kg indicated pronounced hypoplasia of the lungs. Doppler flow patterns through the arterial duct were classified into left-to-right, right-to-left and bidirectional shunting and correlated to the degree of PHT. The additional use of PGE1 to reopen the arterial duct and to stabilize right ventricular function led to an amelioration of severe PHT and preoperative stabilisation in 2 newborns with pronounced pulmonary hypoplasia. All patients underwent successful surgery, and did not show any complications after 2 years follow-up. CONCLUSION: Measurements of lung function parameters and adaptation of mechanical ventilation to the degree of pulmonary hypoplasia and additional therapy with PGE1 may help to improve the outcome in CDH patients.

A new autosomal dominant syndrome of distinctive face showing ptosis and prominent eyes associated with cleft palate, ear anomalies, and learning disability.

We report on three patients from two families with apparently a novel clinical entity. The main features of which include unusual craniofacial dysmorphism with ptosis, prominent eyes, flat midface, Cupid's bow configuration of the upper lip, low-set, posteriorly rotated small ears, as well as conductive hearing loss, cleft palate, heart defect, and mild developmental delay. We suggest that this entity is an autosomal dominant disorder given the occurrence in a mother and daughter as well as in an unrelated boy.

Determinants of bovine thermal response to heat and solar radiation exposures in a field environment.

Continuous exposure of cattle to summer heat in the absence of shade results in significant hyperthermia and impairs growth and general health. Reliable predictors of heat strain are needed to identify this condition. A 12-day study was conducted during a moderate summer heat period using 12 Angus x Simmental (Bos taurus) steers (533 ± 12 kg average body weight) to identify animal and ambient determinations of core body temperature (T(core)) and respiration rate (RR) responses to heat stress. Steers were provided standard diet and water ad libitum, and implanted intraperitoneally with telemetric transmitters to monitor T(core) hourly. Visual count of flank movement at 0800 and 1500 hours was used for RR. Dataloggers recorded air temperature (T(a)), and black globe temperatures (T(bg)) hourly to assess radiant heat load. Analysis was across four periods and 2 consecutive days averaged within each period. Average T(a) and T(bg) increased progressively from 21.7 to 30.3°C and 25.3 to 34.0°C, respectively, from the first to fourth periods. A model utilizing a quadratic function of T(a) explained the most variation in T(core) (R(2) = 0.56). A delay in response from 1 to 3 h did not significantly improve R(2) for this relationship. Measurements at 0800 and 1500 hours alone are sufficient to predict heat strain. Daily minimum core body temperature and initial 2-h rise in T(a) were predictors of maximum core temperature and RR. Further studies using continuous monitoring are needed to expand prediction of heat stress impact under different conditions.

Pediatric radiological diagnostic procedures in cases of suspected child abuse.

Advanced and specialized radiological diagnostic procedures are essential in cases of clinically diagnosed injuries to the head, thorax, abdomen or extremities of a child, especially if there is no case history or if the reporting of an inadequate trauma suggests battered child syndrome. In particular, these diagnostic procedures should aim at detecting lesions of the central nervous system (CNS), so that the treatment can be immediately initiated. If the diagnostic imaging reveals findings typically associated with child abuse, accurate documentation constituting evidence, which will stand up in court, is required to prevent any further endangerment of the child's welfare.

No evidence for interstitial lung oedema by extensive pulmonary function testing at 4,559 m.

The aim of the present study was to better understand previously reported changes in lung function at high altitude. Comprehensive pulmonary function testing utilising body plethysmography and assessment of changes in closing volume were carried out at sea level and repeatedly over 2 days at high altitude (4,559 m) in 34 mountaineers. In subjects without high-altitude pulmonary oedema (HAPE), there was no significant difference in total lung capacity, forced vital capacity, closing volume and lung compliance between low and high altitude, whereas lung diffusing capacity for carbon monoxide increased at high altitude. Bronchoconstriction at high altitude could be excluded as the cause of changes in closing volume because there was no difference in airway resistance and bronchodilator responsiveness to salbutamol. There were no significant differences in these parameters between mountaineers with and without acute mountain sickness. Mild alveolar oedema on radiographs in HAPE was associated only with minor decreases in forced vital capacity, diffusing capacity and lung compliance and minor increases in closing volume. Comprehensive lung function testing provided no evidence of interstitial pulmonary oedema in mountaineers without HAPE during the first 2 days at 4,559 m. Data obtained in mountaineers with early mild HAPE suggest that these methods may not be sensitive enough for the detection of interstitial pulmonary fluid accumulation.

Tympanic temperature in confined beef cattle exposed to excessive heat load.

Angus crossbred yearling steers (n = 168) were used to evaluate effects on performance and tympanic temperature (TT) of feeding additional potassium and sodium to steers exposed to excessive heat load (maximum daily ambient temperature exceeded 32°C for three consecutive days) during seasonal summer conditions. Steers were assigned one of four treatments: (1) control; (2) potassium supplemented (diet containing 2.10% KHCO3); (3) sodium supplemented (diet containing 1.10% NaCl); or (4) potassium and sodium supplemented (diet containing 2.10% KHCO3 and 1.10% NaCl). Overall, additional KHCO3 at the 2% level or NaCl at the 1% level did not improve performance or heat stress tolerance with these diet formulations. However, the addition of KHCO3 did enhance water intake. Independent of treatment effects, TT of cattle displaying high, moderate, or low levels of stress suggest that cattle that do not adequately cool down at night are prone to achieving greater body temperatures during a subsequent hot day. Cattle that are prone to get hot but can cool at night can keep average tympanic temperatures at or near those of cattle that tend to consistently maintain lower peak and mean body temperatures. In addition, during cooler and moderately hot periods, cattle change TT in a stair-step or incremental pattern, while under hot conditions, average TT of group-fed cattle moves in conjunction with ambient conditions, indicating that thermoregulatory mechanisms are at or near maximum physiological capacity.

Assessing the heat tolerance of 17 beef cattle genotypes.

Cattle production plays a significant role in terms of world food production. Nearly 82% of the world's 1.2 billion cattle can be found in developing countries. An increasing demand for meat in developing countries has seen an increase in intensification of animal industries, and a move to cross-bred animals. Heat tolerance is considered to be one of the most important adaptive aspects for cattle, and the lack of thermally-tolerant breeds is a major constraint on cattle production in many countries. There is a need to not only identify heat tolerant breeds, but also heat tolerant animals within a non-tolerant breed. Identification of heat tolerant animals is not easy under field conditions. In this study, panting score (0 to 4.5 scale where 0 = no stress and 4.5 = extreme stress) and the heat load index (HLI) [HLI(BG<25°C) = 10.66 + 0.28 × rh + 1.30 × BG - WS; and, HLI (BG> 25°C) = 8.62 + 0.38 × rh + 1.55 × BG - 0.5 × WS + e((2.4 - WS)), where BG = black globe temperature ((o)C), rh = relative humidity (decimal form), WS = wind speed (m/s) and e is the base of the natural logarithm] were used to assess the heat tolerance of 17 genotypes (12,757 steers) within 13 Australian feedlots over three summers. The cattle were assessed under natural climatic conditions in which HLI ranged from thermonuetral (HLI < 70) to extreme (HLI > 96; black globe temperature = 40.2°C, relative humidity = 64%, wind speed = 1.58 m/s). When HLI > 96 a greater number (P < 0.001) of pure bred Bos taurus and crosses of Bos taurus cattle had a panting score ≥ 2 compared to Brahman cattle, and Brahman-cross cattle. The heat tolerance of the assessed breeds was verified using panting scores and the HLI. Heat tolerance of cattle can be assessed under field conditions by using panting score and HLI.

Medical and endoscopic treatment in peptic ulcer bleeding: a national German survey.

OBJECTIVE: Peptic ulcers are the leading cause of upper gastrointestinal (GI) bleeding. The aim of this study was the evaluation of the recent clinical practice in drug therapy and endoscopic treatment of ulcer bleedings in Germany and to compare the results with the medical standard. METHODS: A structured questionnaire (cross-sectional study) was sent to 1371 German hospitals that provide an emergency service for upper GI bleeding. The project was designed similar to a nationwide inquiry in France in 2001. Forty-four questions concerning the following topics were asked: hospital organisation, organisation of emergency endoscopy service, endoscopic and drug therapy of ulcer bleeding, endoscopic treatment of variceal bleeding. Return of the questionnaires was closed in August 2004. RESULTS: Response rate was 675 / 1371 (49 %). Mean hospitals size was < 200 beds, 49 % (n = 325) had basic care level. 92 % provided a 24-hour endoscopy service, specialized nurses were available in 75 %. Fiberscopes were used only in 15 %. A mean of 10 +/- 12 (range: 0 - 160) bleeding cases/month were treated, 6 +/- 6 cases per month (60 %) were ulcer bleedings. Endoscopy was performed in 72 % immediately after stabilization but in all cases within 24 hours. The Forrest classification was used in 99 % whereas prognostic scores were applied only in 3 %. Forrest Ia,/Ib/IIa/IIb/IIc/III ulcers were indications for endoscopic therapy in 99 %/ 99 %/ 90 %/ 58 %/ 4 %/ 2 % respectively. Favoured initial treatment was injection (diluted epinephrine, mean volume 17 +/- 13 mL/lesion) followed by clipping. In re-bleedings, 93 % tried endoscopic treatment again. Scheduled re-endoscopy was performed in 63 %. PPI were used in 99.6 %, 85 % administered standard dose twice daily. PPI administration was changed from intravenous to oral with the end of fasting in nearly all hospitals. PPI administration schemes can be improved. Indications for Helicobacter pylori eradication followed rational principles. CONCLUSION: Medical and endoscopic treatment of bleeding ulcers reached a high standard, although some therapeutic strategies leave room for improvement. Bigger hospitals tend to be closer to the medical standard.

[Steroid-induced spinal epidural lipomatosis in pediatric patients]. / Kortikosteroid-induzierte spinale epidurale Lipomatose bei pädiatrischen Patienten.

We describe three adolescent patients with chronic autoimmune disorders who developed back pain and, in two cases, spinal symptoms several months after initiating chronic treatment with glucocorticoids. In all cases, MRI showed extensive spinal epidural lipomatosis, a rare but classic untoward effect of chronic glucocorticoid therapy. Analysis of these three, as well as 11 other pediatric cases extracted from the international literature, revealed that spinal epidural lipomatosis manifests most commonly with back pain and within a mean of 1.3 years (range, 3 month-6.5 years) after initiation of therapy with corticosteroids. It frequently remits after reduction of the corticosteroid dose.

Monitoring lung impedance changes during long-term ventilator-induced lung injury ventilation using electrical impedance tomography.

OBJECTIVE: The target of this methodological evaluation was the feasibility of long-term monitoring of changes in lung conditions by time-difference electrical impedance tomography (tdEIT). In contrast to ventilation monitoring by tdEIT, the monitoring of end-expiratory (EELIC) or end-inspiratory (EILIC) lung impedance change always requires a reference measurement. APPROACH: To determine the stability of the used Pulmovista 500® EIT system, as a prerequisite it was initially secured on a resistive phantom for 50 h. By comparing the slopes of EELIC for the whole lung area up to 48 h from 36 pigs ventilated at six positive end-expiratory pressure (PEEP) levels from 0 to 18 cmH2O we found a good agreement (range of r 2 = 0.93-1.0) between absolute EIT (aEIT) and tdEIT values. This justified the usage of tdEIT with its superior local resolution compared to aEIT for long-term determination of EELIC. MAIN RESULTS: The EELIC was between -0.07 Ωm day-1 at PEEP 4 and -1.04 Ωm day-1 at PEEP 18 cmH2O. The complex local time pattern for EELIC was roughly quantified by the new parameter, centre of end-expiratory change (CoEEC), in equivalence to the established centre of ventilation (CoV). The ventrally located mean of the CoV was fairly constant in the range of 42%-46% of thorax diameter; however, on the contrary, the CoEEC shifted from about 40% to about 75% in the dorsal direction for PEEP levels of 14 and 18 cmH2O. SIGNIFICANCE: The observed shifts started earlier for higher PEEP levels. Changes of EELI could be precisely monitored over a period of 48 h by tdEIT on pigs.

Diagnosis and treatment of Guillain-Barré Syndrome in childhood and adolescence: An evidence- and consensus-based guideline.

This evidence- and consensus-based practical guideline for the diagnosis and treatment of Guillain-Barré Syndrome (GBS) in childhood and adolescence has been developed by a group of delegates from relevant specialist societies and organisations; it is the result of an initiative by the German-Speaking Society of Neuropediatrics (GNP), and is supported by the Association of Scientific Medical Societies (AWMF, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften). A systematic analysis of the literature revealed that only a few adequately-controlled studies exist for this particular age group, while none carries a low risk of bias. For this reason, the diagnostic and therapeutic recommendations largely rely on findings in adult patients with GBS, for which there are a higher number of suitable studies available. Consensus was established using a written, multi-step Delphi process. A high level of consensus could be reached for the crucial steps in diagnosis and treatment. We recommend basing the diagnostic approach on the clinical criteria of GBS and deriving support from CSF and electrophysiological findings. Repetition of invasive procedures that yield ambiguous results is only recommended if the diagnosis cannot be ascertained from the other criteria. For severe or persistently-progressive GBS treatment with intravenous immunoglobulin (IVIG) is recommended, whereas in cases of IVIG intolerance or inefficacy we recommended treatment with plasmapheresis. Corticosteroids are ineffective for GBS but can be considered when acute onset chronic inflammatory demyelinating polyneuropathy (A-CIDP) is suspected due to a prolonged disease course. The full German version of the Guideline is available on the AWMF website (https://www.awmf.org/leitlinien/detail/ll/022-008.html).